MONROVIA, Liberia — After five days, the patient became delirious. Doctors decided to give her five milligrams of diazepam. In any modern hospital around the world, it would take at most a few minutes to administer the drug intravenously to calm the agitated woman and help her rest.
But this patient had Ebola, and in a simulation at the new U.S. field hospital here Tuesday, the simple decision set off an arduous effort that took nearly 60 minutes. Had the situation been real, it would have presented life-threatening conditions for the three U.S. Public Health Service workers who administered the drug.
The painstaking process of putting on personal protective equipment, the full-body moonsuits that health-care workers must wear while treating Ebola patients, took the trio about 15 minutes each. The removal procedure, known as “doffing,” lasted 30 to 40 minutes.
“Things went very well,” said Cmdr. Jamal Gwathney, operations section chief at what is technically known as the Monrovia Medical Unit, after the drill attended by two reporters and a photographer. “They were safe in their practices. They were slow and deliberate. The patient got appropriate care and treatment. And now they are doffing [the moonsuits] in a slow and deliberate manner.”
The 25-bed hospital, inaugurated Wednesday in a ceremony that included Liberian President Ellen Johnson Sirleaf and scheduled to open in the coming days, will treat health-care workers only — Americans, Liberians and anyone else willing to take on the risky business of caring for Ebola patients.
The first U.S. Ebola treatment facility in West Africa is designed to inspire confidence that health workers who become infected would receive top-quality care, including intravenous hydration, electrolyte replacement, quick lab results and any necessary drugs in a clean, air-conditioned environment.
All that is available near Monrovia’s main airport in a series of tents like the ones used for field hospitals in combat zones, staffed by 69 members of the Public Health Service. An Ebola diagnosis can be made in three hours at a nearby lab run by the U.S. Army Medical Research Institute of Infectious Diseases, based at Fort Detrick, Md.
According to the World Health Organization, 546 health-care workers are among the 13,042 suspected, probable or confirmed cases of Ebola in eight countries; 310 health workers have died.
“Our whole thing here is to be a beacon of hope, so [staff members] of other NGOs around the world can see if I come down with Ebola, I have a place to go,” said Capt. Calvin Edwards, who runs the facility.
Snow fences divide the facility into “hot” and “cold” zones. Within the hot zone, there are separate wards for suspected, probable and confirmed Ebola cases. Another small ward is for people who may have been exposed through a needle stick or another mishap but are asymptomatic. Traffic flows in one direction only, moving health workers from the suspected ward to the confirmed ward, but never in the other direction. That could bring the virus to someone who doesn’t have it.
Nurses Victoria D’Addeo and Jennifer Daniely buddied up as they donned the personal protective equipment, searching for tiny open spots where skin was exposed, usually at the seams where parts of the outfit meet. Paul Garnoy, the safety monitor, also put on the entire outfit so he could accompany the nurses into the ward.
They duct-taped their sleeves at the wrists, careful to leave a folded tab that could be easily pulled after the procedure without tearing the suit and possibly exposing their skin. They pretended to wash their hands and cleanse their feet in chlorine solution.
Other staff members wrote the three workers’ names and the time they suited up on their outfits for all to see. In the heat and humidity of outdoor Ebola treatment units, workers immediately begin sweating inside the stifling suits. They can work that way for about an hour. In the air-conditioned field hospital, it was a little better.
“It feels workable,” one of the nurses said.
As they walked through the ward, the workers kept their hands knitted together in front of them, as if in prayer. The practice is a way to ensure they don’t touch anything.
The dangerous part is removing the suits, which will be contaminated with the virus if the health-care worker comes in contact with the bodily fluids of a symptomatic patient.
The three workers lined up on marks in the doffing tent and were thoroughly sprayed by a fourth suited worker with what will be a diluted chlorine solution when the hospital opens. The solution will run over the plastic-coated floor and into a gutter at the side of the tent. The process is repeated as each piece of gear is removed, the workers leaning forward so that the fluid drips away from their bodies.
The entire moonsuit, except for the goggles, will be burned in four incinerators on the hospital grounds.